Opiod Overdose Prevention: Overdose Responder Plan York City... · If a person is not breathing and does not have a pulse, the -Pulmonary Resuscitation (CPR) and apply an Automated

OPIOID OVERDOSE PREVENTION: OVERDOSE RESPONDER PLAN

MODULE #1

USE OF INTRANASAL NALOXONE

Instructor Guide

Anti-Kidnapping for International Law Enforcement Investigators C

Module # 1– USE OF INTRANASAL OPIOID OVERDOSE PREVENTION NALOXONE

OPIOID OVERDOSE PREVENTION Module Number 1: OVERDOSE RESPONDER PLAN

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MODULE # 1 SYNOPSIS

Date Prepared: 10/10/2013 Date Reviewed: 04/11/14 Prepared By: Sgt. Walsh, Advanced Training Unit Reviewed/Approved By: Sgt. Mahaan Chandu, Advanced Training Unit This module will provide the participant with a working knowledge of administering intranasal naloxone to an overdose victim. Method of Instruction: Lecture / discussion / demonstration/ practical exercise Time Allocated: 20 Minutes Training Need: To train UMOS in the administration intranasal naloxone to a suspected drug overdose victim. Terminal Learning Objective: At the completion of this module, participants will understand how to recognize a drug overdose and how to treat, at the scene, an overdose victim, including administering intranasal naloxone. Learning Outcomes: 1. List four risk factor for overdosing 2. Recognize three signs of an overdose 3. Perform techniques to stimulate someone who appears to have overdosed 4. Perform CPR 5. Correctly administer naloxone 6. Report use of Naloxone on Department forms Required Reading: Operations Order 49-13, Pilot Program- Use of Naloxone on Persons Suspected to Have Overdosed on Opioid Drugs- 120th Precinct Patrol Guide Procedure 216-19: Public Access Defibrillator Program Instructional Resources Required: - PowerPoint projector - Computer with monitor - Classroom seating /demonstration area/practice area - Practice kits for naloxone administration Evaluation Strategies: - Observation of the level and quality of classroom participation. - Observation and evaluation of module learning outcomes as applied to

classroom exercise. References: NYSDOH OPIOID OVERDOSE PREVENTION “Guidelines for Training Responders” INTRANASAL.NET, “Intranasal Naloxone for acute opiate overdose: Reducing needle stick, improving time to medication delivery.”




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INTRODUCTION

Opioid overdose has become a serious public health issue. In New

York City, overdose is the leading cause of injury death. In 2012, there

were 677 overdose deaths in NYC. Such deaths are often preventable, as

long as a witness to the overdose is knowledgeable to the signs and

symptoms and knows how to respond appropriately.

On April 1, 2006, a new public health law went into effect, making

it legal in N.Y. state for non-medical persons who have successfully

participated in an Opioid Overdose Prevention Program training to

administer any opioid antagonist (naloxone, also known as Narcan) to

another individual to prevent an opioid/heroin overdose from becoming

fatal.

Administering naloxone can be considered a “first aid” response and

can be done without extensive training. The person administering it will

also be covered by the “Good Samaritan” Law, as long as they do so in

good faith.

The use of intranasal naloxone has proven to be effective almost as

rapidly as the IV route Based on this information, intranasal naloxone

would be a better alternative because it reduces the possibility of a needle

stick to rescue providers.

Instructor Notes:

Instructor Notes: An opioid overdose victim can be anyone. Police officers and firefighters are often prescribed pain killers for serious injuries. It’s very easy to take these dangerous drugs in dangerous amounts. Children are curious and may swallow enough pills to cause an overdose. The habitual ‘junkie’ is not always the victim of an overdose.

WHY NALOXONE?

Opioid overdoses kill more people in Staten Island than any

other Borough.

Naloxone reverses the potentially fatal effects of opioids on

the nervous system.

Anyone with access to opioid pain medication, including

children may be at risk of an accidental overdose.

NALOXONE SAVES LIVES




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Learning Outcomes 1. List four risk factor for overdosing 2. Recognize three signs of an overdose 3. Perform techniques to stimulate someone who appears to have overdosed 4. Perform CPR 5. Correctly administer naloxone 6. Report use of Naloxone on Department forms

Learning Outcome #1 Risk Factors for Overdose




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Overdose overview:

Overdose as a cause of death is preventable because a

majority of the time it usually:

Happens to experienced user

Happens over a 1-2 hours, not instantly

Is frequently witnessed by other users or by other

people who can take life-saving actions; and

Can be treated effectively with naloxone(Narcan)

Instructor Notes:





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What drugs are considered opioids?

Opioids include:

Heroin, morphine, codeine, methadone , prescription

narcotics such as oxycodone (Oxycontin, Percodan,Percocet),

hydrocondone(Vicodin), fentanyl(Duragesic), and

hydromorphone(Dilaudid). Naloxone can reverse overdose

caused by any of these opioids.

Naloxone does not work:

o Non-opioid sedating drugs: alcohol,

benzodiazepines(e.g., Valium, Xanax, Clonopin),

Clonidine, Elavil, GHB, Ketamin; nor for

o Stimulates: cocaine, amphetamines(including

methamphetamine and Ecstasy)

Naloxone will often work when a person overdoses on a

mixture of substances, and one of the substances is an opioid.

When you are not sure what substances the person overdosed

on, using naloxone is advised. It is safe. If the person did not

use any opioids, it won’t do any harm.





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Risk Factors for Overdose:

Loss of tolerance: Regular use of opioids leads to a greater

tolerance, i.e. more is needed to achieve the same effect(same high)

Overdoses occur when people start using again following a period

of not using(abstinence) such as incarceration, detox or a “drug

free’ drug treatment.

Mixing Drugs or Polydrug Use: Mixing opioids with other drugs,

especially depressants such as benzodiazepines (Xanax, Clonopin)

or alcohol can lead to an overdose. These combined drugs are

“synergistic”, meaning the combined effect is greater than the effect

would be if they were taken separately. Note: Cocaine is a

stimulant but in high doses can also depress the urge to breathe, so it

too can be particularly risky when combined with opiates.

Instructor Notes:





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Instructor Notes:

Variations in strength of ‘street’ drugs: Street drugs will vary in

strength and effect based on the purity of heroin (or other opioid)

and the amount of other ingredients used to cut the drug. Users

should use small amounts of new batches or inject slowly so they

can get a feel for the quality/ strength of the drug(s).

Serious Illness: If a user has a serious illness, including HIV/AIDS,

liver disease, diabetes and/or heart disease, they are at greater risk of

an overdose. Care should be taken by the user to check the strength

of the drug, avoid mixing drugs and/or using alone.

Using drugs alone is also a risk factor for overdose death.

There is a particularly high risk of overdose death because there is

no one present to initiate rescue measures.




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Signs of an Overdose:

An overdose is more likely to occur 1-2 hours after using an opioid

rather that right after using. After individuals use opioids/heroin, they

should check in regularly with each other to make sure that they are

responsive and not slipping into an overdose.

Signs of an overdose include:

Slowed or shallow breathing

Bluish lips and nail beds resulting from a lack of

oxygen

Heavy nod, not responsive to stimulation-

IMMEDIATE Action must be taken

Learning Outcome #2 Signs of Overdose




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Techniques to stimulate someone who has overdosed:

Yell the person’s name

Shake the person

Do a sternal rub. To do this, make a fist and rub the sternum

(also known as the breastbone) with your knuckles in the

center of the person’s chest and apply pressure while rubbing.

If a person does not respond after 15-30 seconds of doing

this, the situation requires immediate attention.

Call for help

Call for EMS. If you leave the person alone, place them in

the recovery position. Put the person on his/her side. This

will help keep the airway clear and prevent the person

choking on vomit.

Instructor Notes:

Learning Outcome #3 Techniques to Stimulate Overdosed Patient




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Check breathing and response:

Check breathing and response.

If a person is not breathing and does not have a pulse, the

responder should perform Cardio-Pulmonary Resuscitation

(CPR) and apply an Automated External Defibrillator (AED),

as necessary, then administer the naloxone.

If a person is breathing but not responsive, then the responder

should administer naloxone first.

Learning Outcome #4 CPR

Instructor Notes: Perform CPR in accordance with Department guidelines and training.




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Administer Naloxone:

Affix the nasal atomizer (applicator) to the needleless syringe

and then assemble the glass cartridge of naloxone.

Place atomizer within the nostril and tilt head back.

Briskly compress the syringe to administer 1 ml of atomized

spray(half the dose).

Remove and repeat in the other nostril, so all 2 ml of

medication are administered.

Perform rescue breathing while waiting for the naloxone to

take effect.

Instructor Notes:

Learning Outcome #5 Administer Naloxone




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Instructor Notes:

If there is no change within 3-5 minutes, administer another dose

and continue to breathe for them. If second dose doesn’t revive them,

something else is wrong. It has either been too long and the heart has

stopped beating, there are no opioids in their system or the opioids are

unusually strong and require more naloxone. Another option now can

include injectable naloxone, which requires the presence of EMS.




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After administering Naloxone:

Stay with the overdose survivor and provide reassurance that the

drug withdrawal symptoms will decrease in about an hour. Tell

them more drugs (opioids) should not be used now.

Inform EMS of what happened and how much naloxone was used.

Encourage the survivor to go to the hospital

Dispose of the used naloxone device in a trash receptacle

Report your overdose experience on the Aided Report Worksheet or

the Medical Treatment of Prisoner Form; include the where, when,

how many doses of naloxone given

Get a naloxone replacement kit as per the naloxone operations

order.

Learning Outcome #5 Administer Naloxone




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Interactive summary:

Due to the increasing number of opioid overdoses, making naloxone

available to lay people will help reduce the risk of overdose death in a

drug user. The NYPD Pilot program will place this life saving drug in the

hands of first responder who are trained to recognize they symptoms of

overdose and will be able to administer the drug and potentially save a life.

Review the Learning Outcomes:

1. List four risk factor for overdosing

2. Recognize three signs of an overdose

3. Perform techniques to stimulate someone who appears to have

overdosed

4. Perform CPR

5. Correctly administer naloxone

6. Report use of Naloxone on Department forms

Instructor Notes:

Learning Outcome #6 Summary

Learning Outcome #6 Reporting Requirements

Documents

Opiod Overdose Prevention: Overdose Responder Plan York City... · If a person is not breathing and does not have a pulse, the -Pulmonary Resuscitation (CPR) and apply an Automated